Integrating Health into Environmental Impact Assessment

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Integrating

HealthintoEnvironmental Impact

Assessment~ a briefing report for directors and heads of planning and public health ~


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Briefing Reports Collection (available free)

No 1: Dump the Dump! Understanding public concerns at the siting of waste disposal facilities (2004)No 2: Integrating Health into Environmental Impact Assessment (2005)

Written by Salim Vohra, 2005

Contact Details

Dr. Salim VohraLiving Knowledge ConsultingFl 224 Kings Avenue (Kings Court)HounslowMiddlesexTW3 4BL

Mobile: 07 957 476 055Tel: 020 8572 3608Fax: 020 8572 3608

Email: [email protected]: www.livingknowledgeconsulting.com

Printed on recycled paper


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Contents

1. Introduction 12. Health Impact Assessment 23. Environmental Impact Assessment 74. Integrating Health into Environmental Impact Assessment 95. Dealing with Uncertainty: insufficient and contradictory evidence 146. Stakeholder Involvement 187. Commissioning and Scrutinising an Integrated Environmental and Health ImpactAssessment 218 The Wider Context: political, economic and social factors 239. Conclusion 26References 27


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1 . I n t r o d u c t i o n

1. Introduction

The aim of this briefing report is to show directors and heads of planning and public health how they

can ensure that new developments fully take into account the positive and negative health impacts for

residents and local communities by:

1. providing planning and public health professionals with a good understanding and appreciation of the

value of health impact assessment (HIA) in identifying the actual and potential positive and negative

health effects of policies, plans, programmes, projects, and developments;

2. showing planning and public health professionals a mechanism by which they can ask developers to

provide a HIA as well as an environmental impact assessment (EIA) for a proposed development an

integrated environmental and health impact assessment (iEHIA); and

3. enabling planning and public health professionals to commission integrated environmental and health

impact assessments and critically evaluate the strengths and limitations of the resulting reports.

Integrating health into EIA is now part of:

directors and heads of planning and local authorities new public health and shared priorities

obligations to create healthier, safer, stronger and more sustainable communities under the Local

Government Act (2000); and

directors of public health and primary care trusts public health duties to ensure urban and rural

developments create healthier, less inequitable and more cohesive communities and environments

(Choosing Health White Paper and Wanless I and II).

This briefing report is made up of two sections:

Section 1 looks at health impact assessment, environmental impact assessment and integrated

environmental and health impact assessment (iEHIA):

Chapter 2 describes the background, philosophy and methodology of health impact assessment.

Chapter 3 describes the background, philosophy and methodology of environmental impact assessment.

Chapter 4 shows why and how health should be integrated into environmental impact assessment.

Section 2 looks at four important themes that need to be thought through when undertaking an iEHIA:

Chapter 5 examines the issue of having insufficient and contradictory evidence and how this should be managed.

Chapter 6 examines the value of stakeholder involvement and engagement in impact assessment.

Chapter 7 examines how to commission and scrutinise an integrated environmental and health impact assessment.

Chapter 8 examines the wider contextual factors that have a significant influence on the integrated environmental

and health impact assessment process.

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2 . H e a l t h I m p a c t A s s e s s m e n t

2. Health Impact Assessment

Go to the people, live among them

Build on what they know, but of the best practitioners

When their task is accomplished, their work is done

The people all remark, we have done this ourselves

The New Public Health by John Ashton

2.1 What it is

Health impact assessment (HIA) is a relatively new impact assessment methodology. Its roots lie in

environmental impact assessment and the healthy public policy movement. Legislation in the UK requires an

environmental impact assessment (EIA) to be commissioned as part of the planning process and lays down

what areas must be covered in an EIA. EIAs focus largely on key physical environmental factors such as plants

and wildlife, air quality, noise, hydrology and archaeology. In contrast, HIA is currently commissioned

voluntarily. The methodology is not prescribed but informed by international best practice and the focus is

determined by the nature of the policy, plan, programme, project, development or service (called a

development throughout the rest of this document) which is being assessed. Boxes 1 and 2 at the end of

this chapter describe the international context of HIA.

The widely accepted Gothenberg consensus definition of health impact assessment is:

A combination of procedures, methods and tools by which a policy, program or project may be

judged as to its potential effects on the health of a population, and the distribution of those effects

within the population.

WHO European Centre for Health Policy (1999)

HIA is the key systematic approach to identifying the health impacts of proposed and implemented

policies, plans, programmes, projects and services (developments) within a democratic, equitable,

sustainable and ethical framework, so that negative health impacts are reduced and positive health

impacts increased (within a given population). It uses a range of structured and evaluated sources of

evidence that includes public and other stakeholders' perceptions and experiences as well as public

health, epidemiological, toxicological and medical knowledges.

Other impact assessment approaches include social impact assessment, environmental health impact

assessment, technology assessment, strategic environment assessment, sustainability appraisal and health

impact analysis. There are also newer forms of impact assessment such as equalities impact assessment,

regulatory impact assessment and integrated impact assessment. It is not within the scope of this reader to

discuss the similarities and differences of the different approaches in more detail.

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There are several key points to note in the definition given above, many of which have a counterpart in EIA:

HIA draws on many different techniques and sources of evidence;

HIA looks at the potential effects of a development i.e. it tends to be carried out while the development is

at the design or draft stage; HIA identifies the potential for positive and negative effects;

HIA is concerned with the distribution of effects within a population as different groups are likely to be

affected in different ways, and therefore looks at how health and other social inequalities might be

exacerbated by the proposed project, service, programme, policy or development.

In order to examine the ways in which the proposed project, service, programme, policy or development may

be expected to affect the health of particular populations it is important to have a clear understanding of:

the context within which the development is proposed, and

the aims and objectives of the development.

HIA tends to draw on knowledge and information which already exists about a proposed development and

the communities that are likely to be affected i.e. it tends not to undertake specific new research on health

impacts during the assessment.

As with other forms of impact assessment, including EIA, HIA identifies the potential for unintended side-

effects and suggests ways to avoid negative impacts. It is important to appraise a development and examinethe ways in which it might affect people's health and also to consider mitigation and enhancement measures.

Mitigation measures help to reduce the negative health effects and enhancement measures aim to increase

the positive health effects of a given development.

HIA also contributes to the putting together of a monitoring and evaluation strategy for a proposed

development. This can ensure that the negative health effects are indeed reduced and the positive effects

increased for any given project, service, programme, policy or development. It can also enable stakeholders

to develop their own milestones and indicators for evaluating the health positives and negatives of an

development once it is in operation (Cave, Curtis et al, 2001).

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2.2 Why do it

HIA is undertaken because it can help to deliver better and improved policies, plans, programmes, projects,developments and services (developments). The approach can be used:

as a health risk appraisal tool that can help predict the potential negative and positive healthconsequences of developments; and

as aproject managemen toolthat can help to structu e the development and implementation of adevelopment by bringing key stakeholders together; and

t r

as anevaluation toolto monitor the achievement of stated objectives, outputs and outcomes of adevelopment.

2.3 What it doesnt do

At the moment it does not give numerical estimates of the negative and positive health impacts. There is no

approach at present that allows us to do this accurately.

This is because:

many of the effects on an individuals or communitys health are not easily measurable,

many health effects are indirect and take many years to manifest themselves,

the methodology to collect quantifiable health impact evidence and make judgements based upon it

is currently not well developed, and finally

there is argument about the tendency for quantifiable estimates developed for HIAs to give a false

sense of reassurance and precision on what are a range of complex interactions between a range ofsocial, cultural, economic, political, environmental and personal determinants of health.

2.4 How is it done

In 2000 Erica Ison wrote a Resource for HIA(Ison, 2000) and she identified six models or approaches to doing

HIAs. These are:

Merseyside British Columbia

Kirklees Metropolitan Council Swedish County Council

Bielefeld East London

They are named after the areas and countries where they were first developed and used.

They are different in that some provide a broad, quick and simple way of thinking through health impacts

while others have structured and precise steps by which health impacts are identified and assessed in detail.

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They are similar in that they have five core procedural steps (see our HIA Planning, Appraising and

Reporting Toolkit for more details):

Screening:

In this step policies, plans, programmes, projects, developments and services (developments) aresystematically assessed to see whether a HIA needs to be done on them. A quick assessment is made on

their potential to impact on a communitys health. A HIA may not need to be done either because the

development has very little impact on health or the health impacts are well known and the mechanisms to

reduce them are already in place. Screening helps ensure that time, effort and resources are targeted

appropriately. The type of HIA that needs to be undertaken is also determined at this stage.

Scoping:

In this step the terms of reference for the HIA are set i.e. what aspects will be considered, what areas and

groups might need particular focus, what will be excluded from the HIA and how the HIA process will be

managed.

Appraisal:

In this step a systematic review of the potential impacts is undertaken and evidence for these impacts

collected. An assessment of the likely impacts, the size and significance of the effects and the groups that are

likely to be most affected is carried out and described in detail.

Monitoring & Evaluation:In this step ways of monitoring the potential health losses (effects of the negative impacts) and health gains

(effects of the positive impacts) as well as mechanisms to evaluate the development as a whole are

developed. The HIA is also evaluated to assess the accuracy and appropriateness of the health predictions

and recommendations made.

Recommendations:

In this step a report, called a health impact statement, is written and recommendations made on the best way

forward including options to reduce the potential negative health impacts (mitigation measures) and increase

the potential positive impacts (enhancement measures).

2.5 When is it done

HIAs can be done on policies, plans, programmes, projects, developments and services.

They can be done at the:

beginning ........................... during the development or pre-development stage.

middle .............................. ... during the implementation stage.end .............................. ....... at the operation or closure stage to look back and evaluate.

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In HIA terminology:

Prospective HIA.................. means the impact assessment starts as early as possible at the design or draft

stage of a development and recommendations are made on how to maximise

the positive and minimise the negative impacts of the design or draft.Concurrent HIA .................. means the impact assessment starts when the development is underway and

makes recommendations to the planning and delivery team about how the

implementation and operation phase can be modified to reduce the negative and

enhance the positive health effects.

Retrospective HIA .............. means the impact assessment is carried out when the intervention is complete. It

is too late for this development to be changed but lessons can be learnt about

how other similar developments should be designed and implemented.

Some researchers and practitioners suggest that concurrent impact assessment is really monitoring,

retrospective impact assessment is closer to evaluation and that the only true kind of health impact

assessment is prospective (Morgan, 2001).

You can also do quick and broad-brush ones and longer and more detailed ones. In HIA terminology you can

do a rapid, intermediate or comprehensive HIA.

The most important thing to do is to choose a model and approach that makes sense to you and get

going.

Key questions to consider when planning a health impact assessment are:

does the impact assessment look at the intended outcomes or unanticipated effects of the development?

how can or should the public be part of or involved in the process?

do other people, groups and organisations agree or disagree about the nature and significance of the

health impacts?

There is a lot of activity in health impact assessment around the world including in Canada, Australia, New

Zealand, Netherlands, Germany, Thailand, and the USA.

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3 . E n v i r o n m e n t a l I m p a c t A s s e s s m e n t

3. Environmental Impact Assessment

The environment is everything which isnt me.

Albert Einstein

3.1 What is it

EIA is the longest established form of impact assessment, having been carried out around the world for the

last 25-30 years and being part of the regulatory systems of Europe, North America and Australia. There is

gathering momentum to see public concerns and adequate community participation being integrated within

the process framework. In the UK 2,500 EIAs have taken place over the last ten years and this trend is set to

increase. National policies set the context within which local planning authorities approve projects. Though

the public and EIAs, via the environmental statement report, are formally involved at the planning permission

stage there is no formal legislated mechanism by which communities are proactively integrated into either the

project-level EIA process or more strategic environmental assessment (SEA) policy levels (Wathern 1995;

Harrop and Nixon 1999).The simplest definition of EIA is that it is an assessment of the impact of a planned

activity on the environment United Nations Economic Commission for Europe (1991)

3.2 Why do it

EIA is undertaken because it is a statutory requirement or because the planning authority has specifically

asked for one. Its aim like HIA is to help to deliver better and improved developments. Its main use is as an

appraisal tool that can help forecast the potential negative and positive environmental consequences of

developments.


The deficiencies of EIAs are that they

are weak in identifying and evaluating health and social impacts;

have little recognition of the contributions that understanding community perceptions of risk and ofinvolving local communities could have on the EIA process;

have poor involvement of the public and other interest groups before the submission of the

environmental statement;

generate an increasingly combative planning process with developers, planners, communities and

NGO groups tending to be at odds with each other;

do not adequately address the alternatives to a proposed development;

lack a strategic dimension with many EIAs not taking into account the combined or cumulative effect

of other similar developments in a locality or region.

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3 . E n v i r o n m e n t a l I m p a c t A s s e s s m e n t

fail to address a developments impact on global climate, have little focus on the developments long

term sustainability and make little attempt to deal with issues of equity in the distribution of risk

burdens within affected communities.

(Radcliffe and Edward-Jones 1995; Wathern 1995; WHO Healthy Cities Project 1997)

3.4 How is it done

HIAs have been based on EIAs and hence the EIA and HIA process are similar. EIAs also have the five core

steps of:

1. Screening

2. Scoping

3. Appraisal

4. Preparation o the environmental sta ementf t

t

t

t

r

t

t

5. Submission and consultation on environmental sta ement, plus

6. Recommenda ions incorporated into development design

(Harrop and Nixon 1999, BMA 1998)

EIA is tends to use a largely quantitative approach with models and estimates of the likely impact on key

environmental factors in a number of specific categories. These categories are:

Policy context

Socio-economic

Traffic and access

Noise and vibra ion

Air quality

Landscape and visual effects

Contamination and ground conditions

Hydrology and water resou ces

Wind

Sunshine and dayligh

Archaeology and built heritage

Was e and waste management

Ecology

3.5 When is it done

The majority of EIAs are done at the planning permission stage when the developer approaches the planning

authority to gain outline planning consent for the development. Further more detailed EIAs are undertaken

when the detailed design proposals are presented to the planning authority.

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4 . I n t e g r a t i n g H I A i n t o E I A

4. Integrating Health into Environmental Impact

Assessment

The whole is greater than the sum of the parts.

Anon

4.1 What it is

There are three broad approaches to integrating HIAs into EIAs. Thefirstis to undertake an EIA and HIA

concurrently or consecutively and have separate impact statements from two separate sets of consultants.

The second is to have a combined team of two sets of consultants with both teams feeding into and

commenting on both the EIA and HIA aspects to create an integrated environmental and health impactstatement. Thethird is to have a single set of consultants who have both EIA and HIA skills to produce an

integrated environmental and health impact statement.

There is value in each approach and sometimes a planning authority or health agency may ask for an

independent HIA that is separate from the EIA for its own use. However, the second and third approaches

provide the best opportunities for influencing members and local communities and the greatest scope for

modifying the proposals to enhance environmental and health benefits whilst reducing environmental and

health disbenefits.

There are an increasing number of local authorities and primary care trusts who are asking for a separate

HIA or an integrated EIA and HIA (usually with an environmental consultancy teaming up with a health

consultancy to produce a joint proposal).

4.2 Why do it

Integrating HIA into EIA balances out the weaknesses of each approach to create a more robust assessment

of the environmental and health impacts of a proposed development on a locality and its residents. EIA usesa narrower biomedical definition of health and only uses physical death and injury as the cut off between

what is positive and negative health impacts. HIA on the other hand uses a broader social definition of health

that includes perceived wellbeing and the psychosocial mental health impacts as well as physical death and

injury impacts.

The EIAs structure and orientation towards quantitative analysis is balanced by the HIAs less structured, more

flexible and qualitative approach.

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A further strength of HIA is that it is more likely to ensure that residents feel that their concerns have been

listened to and adequately addressed using an approach that is sensitive to their perspectives and

experiences.


It wont guarantee that all the potential impacts of the proposed development are identified or that there willbe no disagreement between stakeholders however it will identify the most important and significant

environmental and health impacts and reduce the conflict and misunderstandings between stakeholders.

4.4 How is it done

The approach is simple. Directors of Planning and Public Health must ask developers to undertake an

integrated environmental and health impact assessment (iEHIA) or a separate HIA and EIA and both

should be involved in the scoping of the key environmental and health aspects that the developer andtheir consultants should investigate.

The process for EIAs and HIAs is broadly similar and increasingly both EIA and HIA practitioners are learning

about each others approaches and their value in the planning process so that they can work with each other.

It will be up to the consultant team to ensure that differences of judgement are worked through so that the

whole team signs up to the implications of the environmental and health impacts identified.

Finally, in comparison to the cost of all commercial developments the costs of an integrated environmentaland health impact assessment are small. Even when compared to the cost of an EIA alone the benefits and

value of doing a HIA as well outweigh the increased cost for the developer.

The key steps for doing a iEHIA are:

1. Ask the developer to undertake an integrated environmental and health impact assessment.

2. Develop the tender specification jointly with the developer the structure and contents of an EIA are well

established and HIA can work within the same process framework.

3. Think through what kind of consultation you want the integrated environmental and health impact

assessment team to undertake.

4. Will you want the team to make recommendations or simply state the positives and negatives and outline

a range of options for mitigation and enhancement.

5. Are there any specific environmental and health concerns that have already been identified that you want

the team to cover.

6. Ideally, there should be an integrated environmental and health impact assessment steering group to

oversee and advise on the integrated environmental and health impact assessment so that key

stakeholders are on-board and the final report has wide credibility and legitimacy.

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7. Take references from previous clients to assess the quality of the teams work and look at previous impact

assessments that they have done. The key question to get an answer to is did the consultant do what

was asked to a sufficiently high quality and do you like the work that they produced.

4.5 When is it done

Like EIAs integrated environmental and health impact assessments are done at the planning permission

stage

4.5 What do the chapters of a iEHIA look like

The overall chapter framework is similar and in line with the legal requirements for an environmental impact

assessment report-statement.

An iEHIA differs from an EIA in that there is: a specific chapter on health, health inequalities and the

methodology used to assess health impacts; each chapter has a specific health impacts section dealing with

the positive and negative health effects of the development; each chapter has specific recommendations to

mitigate (reduce) the negative health effects and enhance (increase) the positive health effects of the

development; and the health impacts section of each chapter link to a more detailed health impact appraisal

matrix provided in the appendix section.

The list below shows the similarities and differences in content between an EIA (contents shown in green) and

the additional elements included in iEHIA (additional content shown in purple):

Policy context+ health policy context

Socio-economic+ health status of local population

Health, inequalities and HIA methodology

Traffic and access+ health effec s o traffic and accesst f

t f t

f f

t f

t f t

Noise and vibration+ health effec s o noise and vibra ion

Air quality+ health e fects o air quality

Landscape and visual effects+ health effects of landscape and visual effects Contamination and ground conditions+ health effects of contamination and ground conditions

Hydrology and water resources+ health effects of hydrology and water resources

Wind+ health effec s o wind

Sunshine and daylight+ health effects of sunshine and daylight

Archaeology and built heritage+ health effects of archaeology

Waste and waste management+ health effec s o waste and waste managemen

Ecology+ health effects of ecology

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Case Study 1 Development Options Assessment, Westbourne Green Triangle, London

In 2002-03 Westminster City Council commissioned an integrated environmental

and health impact assessment from external consultants Arup and BCA. Arup

undertook the environmental impact assessment aspects and BCA undertook the

health impact assessment aspects. The integrated environmental and health impact

assessment examined two development options when compared to a do-nothing

option for a piece of land owned by the Council which currently had a set of council

offices on it as well as some leisure facilities that were used by a range of young

people aged 11-21 years. The two development options considered by the integrated

environmental and health impact assessment team were the building of a new

larger set of council offices with parking facilities for waste disposal lorries and the

building of a new city academy school.

Residents of the area had considerable anger and mistrust towards the Council and

were strongly opposed to any development being undertaken on the site. They felt

that the Council had neglected them and needed to address the concerns they had

about their homes before the Council considered a new development in the area.

They had also had bad experiences of previous construction in the area which had

disregarded noise and work-time limits that had disrupted residents lives and their

quality of life.

The HIA team undertook consultation with local residents, visited them in their own

homes and incorporated their comments into the health sections of the final report.

The consultant team initially thought of providing a stand-alone separate EIA and

HIA report. They then considered a stand-alone health chapter. In the end the team

agreed that each chapter should have a health section and health perspective

incorporated into it.

The final report was well received by both the Council and residents. Residents

disagreed with the consultant teams conclusions but felt that they had been

listened to, that the process had been transparent and that the reasoning used to

arrive at the conclusions was legitimate. The integrated environmental and health

impact assessment also served to bring the Council and local residents closer

together and reduced residents sense of neglect and isolation from the Council by

providing a means of addressing in a small way the power-inequality gap felt by

local residents about their ability to influence their locality.

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Case Study 2 Housing Development, Shotley Peninsula, Suffolk

In 2004, Central Suffolk Primary Care Trust with the knowledge of the local planning

authority asked a developer to undertake a health impact assessment of a

proposed housing development. The local authority had already asked the

developer to undertake an environmental impact assessment and put together a

sustainability appraisal statement.

However these did not address the specific health concerns of local residents on the

Peninsula or examine the impact on health services of a 30-50% increase in the

number of residents on the Peninsula.

The HIA team only undertook consultations with local health providers because of

time constraints and the availability of existing written responses from local

residents about the proposed development.

The final HIA statement examined the implications for local health services, the key

options and their strengths and weaknesses as well as the incorporation of local

perspectives and knowledge about the health impacts of the proposed

development.

Residents were particularly concerned about the traffic implications of the additional

families coming to live on the Peninsula when considering that there was only one

main road off the Peninsula with no possibility of upgrading or widening it.

The HIA confirmed the majority of conclusions provided by the EIA and Sustainability

Appraisal with regards to traffic and the need to mitigate the potential impacts

through road calming and pedestrian safety measures.

The planning process is still ongoing but the feedback from the commissioners hasbeen that the HIA provided additional value and insights in making the decision on

this development.

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5 . D e a l i n g w i t h U n c e r t a i n t y : i n s u f f i c i e n t a n d c o n t r a d i c t o r y e v i d e n c e

5. Dealing with Uncertainty: insufficient and

contradictory evidence

"When one admits that nothing is certain one must, I think, also add that some things are

more nearly certain than others."

Bertrand Russell

5.1 Dealing with lack of evidence and uncertainty of impacts

The key thing to remember is that evidence should be evaluated systematically and the criteria used for its

evaluation be explicitly stated i.e. clear reasons should be given as to why some types of evidence have been

included and others excluded. There are a number of ways that quantitative and qualitative evidence can beevaluated. These are discussed in this chapter, which shows how quantitative and qualitative perspectives

use broadly similar criteria to evaluate and assess the quality of evidence. However it is worth noting that

these criteria are quite difficult to apply and use with the range of evidence available to health and

environmental impact assessment.

Being systematic and thorough in gathering evidence is crucial but there are still many areas where we have

little, weak or no evidence for environmental and health impacts and the mechanisms by which these

impacts occur.

In these situations the question arises as to how to decide and make recommendations when there is little

reliable and robust evidence on the actual and potential health impacts of policies, plans, programmes,

projects, developments and services (developments).

The answer is to use both professional and lay experiential knowledges to help us to contextualise the

evidence from research studies, routine data sources and elsewhere. The views, perspectives and

experiences of local professionals and local residents can be used as another source of evidence as

suggested at the end of Chapter 4.

The next two sections of this chapter show the value of integrating professional and lay experiential

knowledges in helping to create better developments as well as a philosophical perspective that provides a

robust and scientific approach to systematically incorporating lay evidence alongside other types of

quantitative and qualitative evidence.

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5.2 Value of experiential knowledge

The experiential knowledge of lay people can be both important and valuable in assessing the potential

health effects of developments. The two case studies below demonstrate the value and validity of the

experiential knowledge of lay publics.

Herbicide 2,4,5-T controversy in the UK

The scientific Pesticides Advisory Committee in its recommendations on the potential negative health effects of

herbicide use implicitly used an idealised model of the social world where the toxicology lab and its controls

were taken to be a direct and accurate reflection of real world conditions of pesticide usage. Furthermore, the

Committee assumed that conditions of manufacture and transport would be consistent with its social model

where there were no accidents, errors in manufacturing or mistakes in correct usage.

Hence, they dismissed labour union arguments that the herbicide caused health problems because in

practice farmers and farm workers, because of the inconvenience of protective equipment and clothing, did

not to follow the usage instructions. So while farm and forestry workers did not have detailed scientific

knowledge about pesticides they had empirical experiential knowledge of pesticides, their use and the side-

effects of use. In the end, after much debate, the Committee qualified their recommendations with the words

pure 2,4,5-T offers no hazards to users nor to the general publicprovided that the product is used as

directed (Wynne, 1989: 285. Italics in original).

Chernobyl radiation and sheep farmers in the UK

When the UK government realised that radiation from Chernobyl was falling on grazing land inWales,scientists were dispatched to analyse the impact of this on the grass, the sheep eating this grass and

the potential human health implications of eating meat from these sheep.

Government scientists using general models of radiation uptake by plants and animals assumed that the

radiation would decay and disperse in a matter of weeks. However, farmers who observed the work of these

scientists were sceptical because they felt that the scientists were not taking into account local and contextual

information about the type of soil, vegetation and climate. The farmers raised these concerns but the scientists

dismissed them as irrelevant assuming that they had the more reliable knowledge. It was only when the

radiation did not decay and disperse but seemed to be concentrating that the scientists became more open-minded and followed up the issues raised by the farmers.

In both the above examples, each group felt that they had the better knowledge but only from a perspective

outside of both sets of groups can it be seen that each perspective was partial and had usefulness within a

certain domain where it had been tried and tested. It would have been of great value if both sets of

knowledges had been integrated from the beginning. This integration would have occurred sooner if both

sides had been willing to understand the rationality and legitimacy of each others perspectives and

worldviews (Wynne, 1996).

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5.3 Post-normal science

The post-normal science perspective (paradigm) argues that there are three levels of uncertainty: technical,

methodological and epistemological, see Figure 6.1.

Technical uncertainty is about inexactness and can be managed through the use of statistics and normalscience.

Methodological uncertainty is about unreliability and occurs in more complex situations such as those found

in medicine, engineering and professional consultancy where expert judgement is used to overcome the

uncertainty.

Epistemological uncertainty is about a true lack of knowledge where we are ignorant of our ignorance

(Funtowicz and Ravetz, 1992).

Figure 6.1 Diagram of the three levels of uncertainty as described by Funtowicz and Ravetz

This approach argues that for complex societal issues there is a need for an extended peer community

made up of all the affected and interested stakeholders whether they have scientific qualifications or not

who assess and examine the issues as well as develop a range of extended evidence that includes

anecdotal and experiential knowledge as well as scientific evidence to make a societally, culturally andscientifically acceptable decision.

Low LEVEL OF UNCERTAINTY High

AppliedNormal Science

(traditional notions of science)

Expert-ProfessionalJudgement

(use of judgement and good practice)

Post-Normal Science(uncertain facts, disputed values,

high stakes, decisions urgent)

High

Epistemologicalborder with ignorance

MethodologicalDECISIONunreliability

STAKES

Technicalinexactness

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In HIA (and we would argue in any other impact assessment) what is important is to be explicit about whose

perspective and views are being used, whose views have not been collected or excluded and how this

relates to the individuals and groups who are likely to be affected by any actual or proposed policy, plan,

programme, project, development or service.

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6 . S t a k e h o l d e r I n v o l v e m e n t

6. Stakeholder Involvement

Consult: to seek the opinion or advice of another; to take counsel; to deliberate together; to confer.

die.net

Consult: to seek approval for a course of action already decided upon!!

Ambrose Bierce

6.1 Why stakeholder involvement?

Firstly, involving stakeholders is a crucial part of a health impact assessment and its ethos of equity,

democracy, accountability and sustainability. Secondly, as discussed in Chapter 5, only by talking to the

individuals and groups who are or are likely to be affected by a development will we get a rounded picture of

the actual and potential impacts on health and wellbeing. Thirdly, actively listening to and involving thepeople who are likely to be affected by a development is much more likely to generate acceptance and

support for a development and reduce actual and potential conflict, distrust and anger.

There are five key reasons why we would want to get stakeholders involved in a HIA:

to elicit the likes and dislikes of local people and others about a development;

residents both existing and new will face the direct positive and negative health consequences of the

development;

residents and other stakeholders have valuable experiential knowledge that they have built up over the

years about the locality in which they live and work and the impacts of past developments;

not adequately and appropriately addressing residents concerns can and does lead to residents

experiencing social and psychological distress; and

allowing residents and others to have a voice and influence in community processes and thereby

reducing the sense of social exclusion, democratic deficit and inequity.

Central to the development of any stakeholder involvement and participation strategy including that within

an EIA, HIA or iEHIA - is the need to be clear about why stakeholder involvement is being sought and how

these stakeholders views and perspectives will be incorporated into any resulting assessment report, policy,

plan, programme, project, development or service.

6.2 Levels of stakeholder involvement

Sherry Arnsteins Ladder of Participation (Arnstein, 1969) is an internationally influential framework for

understanding and classifying approaches to public participation. At the bottom of her scale, participation is

simply non- or contrived participation where the aim is to appear to be involving and consulting a wide range

of stakeholders. At the other end is citizen power-sharing where communities and residents have varying

degrees of control and influence throughout the whole process of developing a policy, plan, programme,

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project, development or service. In-between there is tokenistic power-sharing where participation is at best

simply informing local people about a course of action or listening to them without making an explicit

commitment to use their views and at worst an attempt to keep residents quiet.

Figure 6.1 Diagram of Sherry Arnsteins Ladder of Participation

Greaterandmore

genuinestakeholderinvolvement

Degrees of citizen power-sharing

Citizen Control

Delegated Power

Partnership

Degrees of tokenistic power-sharing

Placation

Consultation

Informing

Non-participation (contrived participation)

Therapy

Manipulation

It is therefore critical to work out and be explicit with stakeholders and the community about the level at whichyou are involving them so that there is no misunderstanding about the level of influence and power-sharing

that will be taking place. There are times when involvement is about informing or listening to other peoples

views whilst being explicit about being unable to make a commitment to incorporate those views and other

times when there is a two-way partnership and considerable power-sharing and influence being given to the

views, perspectives and judgements of all those being involved in the HIA or development.

6.3 Approaches to stakeholder involvement

There are a range of methods of involving stakeholders including:

1. Public/community meetings

These tend to be the easiest to set up but the hardest to manage. Public meetings involve organising a

venue and meeting time that is accessible and convenient for all relevant stakeholders. Having a meeting

agenda agreed to by key stakeholders beforehand along with allocated times for speakers and a Chair

who will be firm with hecklers is crucial to running a good public meeting.

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2. Street interviews

These are informal interviews conducted in busy areas such as community centres, social clubs,

shopping centres and other venues where key stakeholders may be found. They tend to be held standing

up and follow a structured approach using a standard set of questions.

3. Survey questionnaires

These tend to be sent out by post with a couple of reminders for people who do not return the

questionnaire by a set time. Questionnaires sent out to named individuals tend to have a higher

response rate than those that are mailed to a general person such as The Occupier. Even named

questionnaires tend to have a low response rate. A response rate of over 10% for unnamed and 30% for

named questionnaires is considered very good.

4. Focus groups

This is where key stakeholders are brought together in small groups usually between six and twelve

people to discuss an issue or concern in depth. They require considerable preparation and a facilitator

and note-taker.

5. Key informant interviews

These are one-to-one interviews with key professionals and community representatives, e.g. community

centre coordinator, Chair of a local residents association, and usually last an hour with a single

interviewer tape-recording the interview and then typing it up later.

6. Community involvement/consultation groups

These are more long term focus groups where key stakeholders are asked to form a consultation group

that will feed in its views during the design, implementation and operation of an development usually

over a period of months and years.

7. Citizen panels/juries

These are similar to consultation groups but tend to be formed around specific national or local themes of

concern e.g. genetically modified crops, human embryo research, etc. and involve a representative

sample of people from an area, region or society to enable a representative view to be gained

The best approach is to use a range of methods and then see which ones work and follow these up. This is

because what works in one community today may not work in other communities or in the same community

a few years later.

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7 . C o m m i s s i o n i n g a n d S c r u t i n i s i n g a H I A

7. Commissioning and Scrutinising an Integrated

Environmental and Health Impact Assessment

Consultant: a specialist who gives expert advice or information.Collins English Dictionary

Consultant: someone who bor ows your watch, tells you the time and then charges you for the privilege.The Timesr

r

7.1 Commissioning

Environmental and health impact assessments (EIAs and HIAs) are commissioned for a range of different

reasons and this tends to lead to different ways in which they are taken forward.

An integrated environmental and health impact assessment can be commissioned because: it is part of a legal duty,

it is seen as good practice,

it is seen as a way of providing information to help with designing and developing a policy, plan,

programme, project, development or service (development),

it is a way of b inging key stakeholders together to discuss a development,

it is seen to help build trust among other stakeholders, especially communities, by showing that their

concerns are being taken seriously,

it is seen as providing credible evidence in legal settings, for example, planning enquiries and other

judicial hearings,

a mixture of the above.

It is important to be clear and explicit about why an EIA, HIA or integrated environmental and health

impact assessment (iEHIA) are being commissioned so that external consultants have a clear

understanding of what they are required to do. It will also help later when the report and its

recommendations are being judged by others to see how well these objectives have been met.

The key questions to ask in framing any proposed impact assessment include: What is the purpose of the impact assessment?

How will the findings be used will they guide design, assist implementation, reduce negative effects

and/or improve the positive health effects of a development?

Setting up an iEHIA steering or working group that either advises on or project manages the iEHIA can be a

useful way to ensure that all stakeholders understand and are clear about the scope and limits of the iEHIA.

Creating a group like this with all the key stakeholders represented ensures that the findings and

recommendations of both the HIA and the EIA are credible and used to inform the design and

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7 . C o m m i s s i o n i n g a n d S c r u t i n i s i n g a H I A

implementation of the development being assessed. However, steering groups need a lot of time and

resources to set up and maintain and so are diff icult to do well when time is short and resources lacking.

For external consultant-practitioners, references from previous clients are very useful in assessing the quality

of their work but the best way is to review actual copies of previous HIA statements that they have producedas this will provide a more detailed insight into whether their approach meets your needs and expectations.

As for costs, a good rule of thumb is that, a rapid HIA is likely to cost between 5-10,000, an intermediate HIA

requiring a community consultation between 15-20,000 and a comprehensive HIA with a wide stakeholder

consultation between 20-30,000.

Clear lines of supervision and communication between external consultants are vital. A clear integrated

environmental and health impact assessment workplan and timetable can ensure that both the HIA and EIA

components run to deadline and within budget.

Getting other colleagues or another HIA practitioner to critically review the final iEHIA statement can throw up

errors of fact, especially about local context issues, as well as identify where judgements might be seen as

unjustified because they are based on weak, controversial or little evidence.

Finally, a good understanding of the strengths and limitations of EIAs and HIAs will ensure that commissioners

are realistic about what they can deliver and achieve and what they cannot.

ti

7.2 Scrutinising

The issues considered in commissioning an iEHIA are also pertinent for scrutinising and evaluating an

integrated environmental and health impact assessment statement.

Key questions to ask are:

What is the scope of the iEHIA and the definitions of environment and health used?

Was the methodology used appropriate, explicit and logical?

What evidence and sources of evidence were included and excluded and was the jus fication given explicit,

reasonable and appropriate?

Was there any stakeholder involvement, if so were a range of stakeholders consulted and was the justification for

having or not having stakeholder involvement explicit, reasonable and appropriate?

Was the appraisal of impacts systematic and the reasons for judging the significance and extent of the positive and

negative health effects explicit, appropriate and justified?

Do the recommendations, including mitigation and enhancement measures, follow on from the key issues

emerging from the appraisal?

Is the report as a whole clear, coherent and understandable?

Does the iEHIA statement achieve the integrated environmental and health impact assessments aims andobjectives?

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8 . T h e W i d e r C o n t e x t : p o l i t i c a l , e c o n o m i c a n d s o c i a l f a c t o r s

showed that they thought that residents had an equal if not greater influence on the planning and

implementation of the local development.

Figure 9.1: Stakeholder mapping by local residents for a local development(figures in brackets give the number of residents who placed the stakeholder in that category

7 residents undertook this exercise)

A HIGH importance / LOW in uencefl f.

Residents (7)Residents Association (7)Local Shops & Businesses (7)ISCA (6)FoE/ Greenpeace (4)Environmental Health Dept (3)

B. HIGH importance / HIGH in luence

Developer (6)Planning Dept. (5)EIA Consultants (paid by council) (5)Councillors (4)NLWA (4)PH Dept (3)EIA Consultants (paid by developer) (3)

C. LOW importance / LOW in luencef

School of Community Health (2)

D. LOW importance/ HIGH influence

Local newspaper (4)GLA (3)Judiciary (3)

Low HighINFLUENCE

(in terms of the planning and implementation of the development)

High

IMPORTANCE

9.4 Diversity of stakeholders that need to be involved

Involving a range of stakeholders is important but it also needs to be recognised that there will be a range

and diversity of views within a stakeholder group, e.g. amongst health professionals as well as between

health professionals and local residents. This diversity itself will create differing expectations, perspectives,

desires, priorities and so on which can lead to conflict and opposition. This is one of the reasons why these

stakeholders and their views need to be incorporated into any development (including the integrated

environmental and health impact assessment itself) so that as many voices as possible are included in the

assessment, design and implementation process.

9.3 Complexity of proposed development

The more radical and complex the design and implementation of a development the more difficult and more

easily disrupted it is likely to be. Here again, support by as many stakeholders as possible as well as a

phased and monitored approach to design and implementation are crucial.

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8 . T h e W i d e r C o n t e x t : p o l i t i c a l , e c o n o m i c a n d s o c i a l f a c t o r s

9.5 Lack of clarity about the development

Lack of a clear vision and rationale for the proposed development can be a significant stumbling block to

achieving real and lasting improvements. It is therefore better to have a small number of clear and achievable

objectives and a realistic vision than unrealistic, vague and over-ambitious objectives.

9.6 Changing social, cultural, political, and economic environment

New social, cultural, political and economic issues in the wider society and local community need to be

incorporated into the assessment process. This is one of the strengths of the HIA in contrast to the EIA

approach in that it provides a considerable degree of flexibility and adaptability to changing needs and

circumstances.

These wider contextual factors include recessions, local and national elections, changes in local employment,

demographic changes e.g. new communities entering the area, or cultural ideas endorsed by celebrities who

can influence community lifestyles and life choices. All of these are difficult to capture at a single point in time.

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9 . C o n c l u s i o n

9. Conclusion

The journey of a thousand miles begins with a single step

Chinese proverb

This reader has explored a number of key aspects of health impact assessment in relation to environmental

impact assessment including what it is, why its done, how its done, when its used and how it should be

commissioned.

Health impact assessment is a flexible methodology for understanding the varying health impacts both

positive and negative, that policies, plans, programmes, projects, developments and services (developments)

can have on the individuals and communities that they are targeted at as well as on those that are not thespecific targets of the development in question.

Health impact assessment is a relatively new approach that is still evolving and there are different ways of

doing it depending on the particular development, the local context, the perspective of the assessor and the

time and resources available. HIAs roots are in EIA and therefore it follows a broadly similar framework and

process to EIA and its practitioners can and are able to work with each other to create an integrated

environmental and health impact assessment statement.

Integrating HIA into the EIA process helps to ensure that positive and negative environmental and healthimpacts are identified and that mitigation and enhancement measures are developed and implemented.

Directors of Planning and Public Health must ask developers to undertake an IEHIA or a separate HIA

and EIA and ensure that the findings are incorporated into a development so that it provides the

greatest benefits and the fewest costs to the local environment and to local communities. In comparison

to the total costs of a development the costs of an integrated environmental and health impact

assessment or an EIA and HIA are small.

Properly integrating EIA and HIA is about more than simply carrying out an EIA and HIA at the same time as

there are important issues that need to be thought through to create a wholly integrated environmental and

health impact assessment. We hope this manual has given you enough knowledge and understanding to

enable you to undertake and commission your own integrated environmental and health impact

assessments. We hope that we have given you the springboard to start your own integrated environmental

and health impact assessment adventure and journey

Good luck and bon voyage!

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R e f e r e n c e s

References

(2003). Measurement on health. Epi5251 online course notes.http://courseweb.edteched.uottawa.ca/epi5251/Index_notes/Definitions%20of%20Health.htm . University of Ottawa.

Adams, J. (2001). Risk. London: Routledge.

Arnstein, S. (1969). A ladder of citizen participation in the USA. Journal of the American Institute of Planners 35, 216-24.

Bardsley, M., Cave, B., Jacobson, B. et al. (2001). Monitoring regeneration and health: a health indicators toolbox forpractitioners. London, Health of Londoners Programme.Available: http://www.holp.org.uk

British Medical Association (1998). Health & Environmental Impact Assessment: an integrated approach. UK, Earthscan.

Cave, B. and Curtis, S. (2001). Health impact assessment for regeneration projects. Volume I: A practical guide. London,

East London and the City Health Action Zone and Queen Mary, University of London.Available: http://www.geog.qmul.ac.uk/health/guide.html

Cave, B., Curtis, S., Cooke, A. et al. (2003). How important is public participation for health impact assessment? draft.

Cave, B., Curtis, S., Coutts, A. et al. (2001). Health impact assessment for regeneration projects. Volumes I-III. London, EastLondon and the City Health Action Zone and Queen Mary, University of London .Available: http://www.geog.qmul.ac.uk/health/guide.html

Cave, B. and Penner, S. (2001). Frequently asked questions about HIA. London, Queen Mary, University of London.Available: http://www.geog.qmul.ac.uk/health/guide.html

Connell, J. P. and Kubisch, A. C. (1998). "Applying a theory of change approach to the evaluation of comprehensivecommunity developments: progress, prospects, and problems," in New approaches to evaluating community

developments. Volume 2 Theory, measurement, and analysis. Edited by K. Fulbright-Anderson, A. C. Kubisch, and J. P.Connell, Washington DC: The Aspen Institute.

Connell, J. P., Kubisch, A. C., Schorr, L. B. et al. (1995). New approaches to evaluating community developments: concepts,methods & contexts. Washington DC: The Aspen Institute.

Dahlgren, G. and Whitehead, M. (1991). Policies and strategies to promote social equity in health. Stockholm, Institute forFuture Studies.

Devers, K. J. (1999). "How will we know 'good' quality research when we see it?" Beginning the dialogue in health servicesresearch. Health Services Research 34, 1153-88.

Funtowicz, S. O. and Ravetz, J. R. (1992). "Three types of risk assessment and the emergence of post-normal science," inSocial theories of risk. Edited by S. Krimsky and D. Golding, Westport, Conn. ; London: Praeger.

Guba, G. E. and Lincoln, Y. S. (1994). "Competing paradigms in qualitative research," in Handbook of qualitative research.Edited by N. K. Denzin and Y. S. Lincoln, Thousand Oaks: Sage.

Harrop, D. O. and J. A. Nixon (1999). Environmental Assessment in Practice. London, Routledge.

Inui, T. S., and Frankel, R. M. (1991). Evaluating the quality of qualitative research: a proposal pro-tem. Journal of GeneralInternal Medicine 6, 485-86.

Ison, E. (2000). London's Health: developing a vision together. Resource for health impact assessment. London,commissioned by NHS Executive.Available: http://www.londonshealth.gov.uk/allpubs.htm#hia

Judge, K., Barnes, M., Bauld, L. et al. (1999). Health Action Zones: learning to make a difference. Findings from apreliminary review of Health Action Zones and proposals for a national evaluation. A report submitted to the Departmentof Health, 1-120. Health Action Zones The National Evaluation Team.

Page 27
http://courseweb.edteched.uottawa.ca/epi5251/Index_notes/Definitions%20of%20Health.htmhttp://www.holp.org.uk/http://www.geog.qmul.ac.uk/health/guide.htmlhttp://www.geog.qmul.ac.uk/health/guide.htmlhttp://www.geog.qmul.ac.uk/health/guide.htmlhttp://hia/http://hia/http://www.geog.qmul.ac.uk/health/guide.htmlhttp://www.geog.qmul.ac.uk/health/guide.htmlhttp://www.geog.qmul.ac.uk/health/guide.htmlhttp://www.holp.org.uk/http://courseweb.edteched.uottawa.ca/epi5251/Index_notes/Definitions%20of%20Health.htm


32/34

R e f e r e n c e s

Available: http://www.ukc.ac.uk/PSSRU/downloads/ddp1546.html

Last, J. M. (1995). A dictionary of epidemiology. New York: Oxford University Press.

Morgan, R. (2001). Impact assessment, monitoring and auditing.

Pawson, R. and Tilley, N. (1997). Realistic evaluation. London; Thousand Oaks, Calif.: Sage.

Radcliffe, A. and G. Edward-Jones (1995). The Quality of Environmental Assessment Process: a case study on clinicalwaste incineration in the UK. Project Appraisal 10(1): 31-38.

United Nations Economic Commission for Europe (1991). Policies and systems of environmental impact assessment. UnitedNations, Geneva

Varty, S. (2002). Environmental health indicators: framework and methodologies.http://www.northampton.ac.uk/ncr/who/ . University of Northampton.

Vingilis, E., and Sarkella, J. (1997). Determinants and indicators of health and well-being: tools for educating society on thesustainability of well-being. Social Indicators Research 6, 1-20.

Wathern, P., Ed. (1995). Environmental Impact Assessment: theory and practice. London, Routledge.

Weiss, C. H. (1995). "Nothing as practical as good theory: exploring theory-based evaluation for ComprehensiveCommunity Developments for children and families," in New approaches to evaluating community developments.Concepts, methods, and contexts. Edited by J. P. Connell and others, Washington DC: The Aspen Institute.

Whitehead, M. (1995). "Tackling inequalities in health: a review of policy developments," in Tackling inequalities in health:an agenda for action. Edited by M. Benzeval, K. Judge, and M. Whitehead, pp. 22-52. London: King's Fund Publishing.

WHO Healthy Cities Project (1997). City Planning for Health & Sustainable Development. Copenhagen, WHO (Europe).

WHO European Centre for Health Policy. (1999). Health impact assessment: main concepts and suggested approach.Gothenburg consensus paper. 1-10. Brussels, WHO Regional Office for Europe, ECHP.Available: http://www.who.dk/document/PAE/Gothenburgpaper.pdf

Wynne, B. (1989). "Building public concern into risk management," in Environmental threats: perception, analysis andmanagement. Edited by J. Brown, London: Belhaven.

Wynne, B. (1996). ""May the sheep safely graze?" a reflexive view of the expert-lay knowledge divide," in Risk, environmentand modernity: towards a new ecology. Edited by S. Lash, B. Szersynski, and B. Wynne, London: Sage.

Page 28
http://www.ukc.ac.uk/PSSRU/downloads/ddp1546.htmlhttp://www.northampton.ac.uk/ncr/who/http://www.who.dk/document/PAE/Gothenburgpaper.pdfhttp://www.who.dk/document/PAE/Gothenburgpaper.pdfhttp://www.northampton.ac.uk/ncr/who/http://www.ukc.ac.uk/PSSRU/downloads/ddp1546.html


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About the Author

Salim's background is in Medicine, Environmental Epidemiology, Public Health Policy and CommunityDevelopment. He has a degree in Medicine (MBChB) from the University of Leicester, a Master of Science

(MSc) in Environmental Epidemiology and a Doctor of Philosophy (PhD) in Public Health and Policy from theLondon School of Hygiene & Tropical Medicine (University of London).

He has taught at the London School of Hygiene & Tropical Medicine on environmental health, statistics andepidemiology.

He has broad experience of environmental and public health consultancy and has expertise in publicperceptions of environmental and health risks and impact assessments including their development andapplication in a range of organisations.

He has also worked in the voluntary sector leading, managing and fundraising for a range of communitycentres delivering a variety of community-based services including advice and guidance, training andeducation, social welfare and cultural diversity and enhancement in socially-excluded and deprived areasof Lancashire and London.

He is, and has been for the last six years, a non-executive director of the West Middlesex UniversityHospital where he has chaired the clinical governance committee, is lead trustee for an innovative westLondon cancer information and support centre `The Mulberry Centre' and a member of the humanresources and remuneration committee and the clinical effectiveness and standards committee. He hasbeen a member and Chair of the NHS Hounslow District Research Ethics Committee and Co-chaired thesuccessful merger of the Hounslow District and Hillingdon Research Ethics Committee.

Salim is a Fellow of the Royal Institute of Public Health and a member of the International Association ofImpact Assessment, the Society for Risk Analysis and the European Association for the Study of Science andTechnology.

About Living Knowledge

We are an environmental and public health consultancy working at the interface between risk, health andthe environment.

We use a public and community-centred approach that emphasises the need to enhance and developmeaningful, sustainable and trusting relationships between communities, voluntary organisations, publicinstitutions and private businesses.

Our approach blends qualitative and quantitative methods to create risk, health and environmentalcommunication and management solutions that help build long-term, fruitful and beneficial partnershipsbetween individuals, communities and organisations.

We provide consultancy, training and research services on risk, health and environmental issues from thesiting of mobile phone transmitter masts and waste disposal facilities to public concerns over the tripleMMR vaccine and genetically modified crops.

We have worked on health impact assessments for Suffolk PCT, London Development Agency, TowerHamlets PCT, Bedford Borough Council and Westminster City Council.

We have contributed to the development of models on integrated impact assessment (London HealthCommission), on integrating health and equalities impact assessment (Greenwich Borough Council), ashort HIA tool for Newport Council to aid the development of their Health & Social Care Strategy and theSeahorse IA Planning, Appraising and Reporting Toolkit.

We have also developed and delivered 1 and 2 day HIA training programmes for Tower Hamlets PCT,Newport Council, the Isle of Wight Children's Fund and Kingston PCT.


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For more information on environmental and public health consultancy, training and research contact us at:

Living Knowledge ConsultingFl 2, 24 Kings Avenue (Kings Court), Hounslow, Middlesex. TW3 4BL

Tel and Fax: 020 8572 3608

Email: [email protected]: www.livingknowledgeconsulting.com
mailto:[email protected]://www.livingknowledgeconsulting.com/http://www.livingknowledgeconsulting.com/mailto:[email protected]

Integrating Health into Environmental Impact Assessment

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